Disparities in Stage at Diagnosis in an Equal-access Integrated Delivery System: A Retrospective Cohort Study of 7244 Patients With Bladder Cancer

BackgroundDisparities in bladder cancer survival by race/ethnicity and gender are likely related to differences in diagnosis. We assessed disparities in stage at diagnosis and potential contributing factors within a large, integrated delivery system.Patients and MethodsWe conducted a retrospective cohort study of 7244 patients with bladder cancer age ≥ 21 years diagnosed from January 2001 to June 2015 within Kaiser Permanente Southern California. Bivariate analyses compared stage at diagnosis – as well as comorbidities, health plan membership length, and health care utilization prior to diagnosis – by race/ethnicity, gender, and age. Multivariable generalized linear mixed models with urologist as a random effect were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for diagnosis of muscle-invasive bladder cancer (MIBC) versus non–muscle-invasive bladder cancer.ResultsIn multivariable analyses, stage at diagnosis varied significantly by race/ethnicity (P < .001). Non-Hispanic black patients had significantly higher odds of being diagnosed with MIBC than non-Hispanic white patients (OR, 1.33; 95% CI, 1.05-1.67), whereas Asian patients had significantly lower odds (OR, 0.67; 95% CI, 0.49-0.91). Women were significantly more likely to be diagnosed with MIBC than men (OR, 1.40; 95% CI, 1.22-1.61). Non-Hispanic black women had the highest proportion (39%) of MIBC diagnoses. Among Hispanic and Asian patients, a greater proportion of diagnoses occurred at younger ages.ConclusionsHealth care coverage within an equal-access system did not eliminate disparities in stage at diagnosis by race/ethnicity or gender. Studies are needed to identify etiologic factors and aspects of care delivery (eg, patient-physician interactions) that may affect the diagnostic process to inform efforts to improve health equity.     

Racial Disparities in Clinical Outcomes on Investigator-Initiated Breast Cancer Clinical Trials at an Urban Medical Center

BackgroundBlack women are 40% more likely to die of breast cancer compared to White women. Inadequate representation of Black patients in clinical trials may contribute to health care inequity. We aimed to assess breast cancer clinical outcomes in Non-Hispanic Black (Black) versus Non-Hispanic White (White) women with metastatic breast cancer (MBC) enrolled on investigator-initiated clinical trials at Winship Cancer Institute at Emory University, given the significant number of patients from underrepresented minority groups seen at Winship.Materials and MethodsBlack and White women with MBC on investigator-initiated trials at Emory between 2009 and 2019 were retrospectively evaluated. Univariate analyses and multiple logistic regression models were used to assess clinical response and treatment toxicities. Differences in overall survival between groups was assessed using quantile analysis.ResultsSixty-two women with MBC were included (66% White vs. 34% Black). Black patients had less clinical benefit from the trial therapy as only 57% had partial response or stable disease as best response compared to 78% of White women (P = .09). Quantile analysis showed significant difference in mean survival between Whites and Blacks by the end of follow up (64 vs. 38 months). There were no significant differences in toxicities between groups.ConclusionParticipation rates of Black women with MBC on investigator-initiated clinical trials at an urban cancer center were higher compared to key national trials. Black women had worse treatment response and survival. These results reinforce the need for assessment of tumor differences by ancestry and continued improvement in minority representation on clinical trials.     

Evidence That Established Lung Cancer Mortality Disparities in American Indians Are Not Due to Lung Cancer Genetic Testing and Targeted Therapy Disparities

BackgroundAmerican Indians and Alaska Natives (AI/AN) continue to experience extreme lung cancer health disparities. The state of Minnesota is home to over 70,000 AI/AN, and this population has a 2-fold increase in lung cancer mortality compared to other races within Minnesota. Genetic mutation testing in lung cancer is now a standard of high-quality lung cancer care, and EGFR mutation testing has been recommended for all adenocarcinoma lung cases, regardless of smoking status. However, genetic testing is a controversial topic for some AI/AN.Patients and MethodsWe performed a multisite retrospective chart review funded by the Minnesota Precision Medicine Grand Challenge as a demonstration project to examine lung cancer health disparities in AI/AN. We sought to measure epidemiology of lung cancer among AI receiving diagnosis or treatment in Minnesota cancer referral centers as well as rate of EGFR testing. The primary outcome was the rate of EGFR mutational analysis testing among cases and controls with nonsquamous, non–small-cell lung cancer. We secured collaborations with 5 health care systems covering a diverse geographic and demographic population.ResultsWe identified 200 cases and 164 matched controls from these sites. Controls were matched on histology, smoking status, sex, and age. In both groups, about one third of subjects with adenocarcinoma received genetic mutation testing.ConclusionThere was no significant difference in mutation testing in AI compared to non-AI controls at large health care systems in Minnesota. These data indicate that other factors are likely contributing to the higher mortality in this group.     

Patient Characteristics at Prostate Cancer Diagnosis in Different Races at an Academic Center Serving a Diverse Population

Background

In the United States, the prostate cancer (PCa) incidence and death rate has been greater in non-Hispanic black (NHB) men than in non-Hispanic white (NHW) men and slightly lower in Hispanic men than in NHW men. We compared the sociodemographic and baseline prognostic factors at the diagnosis of PCa in different races/ethnicities at a large, academic center serving an ethnically diverse population.

Disparities in Access and Regionalization of Care in Testicular Cancer

Introduction

Timely mobilization of specialized resources are needed to achieve optimal outcomes in testicular cancer. We used the National Cancer Database to investigate the hospital and demographic features driving disparity.

Preoperative Serum Prostate-specific Antigen, Clinical Stage and Gleason Sum as Basis for Predicting Final Pathological Stage in Japanese Patients with Prostate Cancer

By logistic regression analysis and log-likelihood ratio chi-squaretest, the usefulness of preoperative variables (prostate specificantigen [PSA], clinical stage and biopsy Gleason sum) for predictingthe final pathological stage was assessed in 77 patients withclinically resectable prostate cancers. Pathologically, 32 (41.6%)had organ-confined disease. Extracapsular extension was foundin 41 (53.2%), seminal vesicle involvement in 30 (39.0%), positivepelvic lymph nodes in 10 (13.0%) and a positive surgical marginin 27 (35.1%). Each preoperative variable was found to be significantlyassociated with the final pathological stage. Any combinationof these variables was more predictive for extraprostatic disease,compared with each individual. variable. Extraprostatic spreadwas found more frequently in patients with lower serum PSA inthis Japanese elderly male population compared with North Americanmales. These preoperative variables considered in combinationmay provide valuable information for management decisions relatedto prostate cancer. Serum PSA alone cannot reliably predictpathological stage on an individual basis except in patientswith a PSA level of 20 ng/ml or greater. The high incidenceof extraprostatic spread at intermediate PSA underscores theimportance of selecting an ideal cutoff value for PSA-basedscreening in a Japanese male population.     

Use of Patient and Disease Characteristics as Predictive Indicators of Rituximab Infusion-Related Reactions in Adult Malignant Hematology Patients at an Academic Medical Center

BackgroundIdentification of predictive indicators for rituximab infusion-related reactions (R-IRRs) may allow clinicians to modify treatment plans for patients at high risk of reaction to reduce incidence. Use of predictive indicators would significantly improve the patient experience, reduce hospital resource utilization, and decrease infusion chair time.Patients and MethodsThis retrospective, single-center, observational study evaluated 173 adult malignant hematology patients who received their first dose of rituximab inpatient between July 31, 2015 and July 31, 2018. Patients were excluded if they received prior rituximab, and/or induction chemotherapy, or were pregnant at the time of exposure. The primary outcome was the overall incidence of R-IRRs during the study period. The secondary outcomes were associations between specific patient and disease characteristics and R-IRRs.ResultsOf the 173 patients evaluated, 109 met inclusion criteria and 64 were excluded. The overall incidence of R-IRRs was 31 (28.4%) of 109. The following patient and disease characteristics were significantly associated with R-IRRs on univariate analysis: higher actual body weight (P = .04), diagnosis (P = .01), lower hemoglobin (P = .02), and bone marrow involvement (P = .001). In a confirmatory stepwise regression model, higher actual body weight (P = .01) and bone marrow involvement (P = .003) were positively associated with R-IRRs.ConclusionActual body weight and bone marrow involvement may be utilized as potential predictive indicators of R-IRRs. Further study is needed to validate these indicators and determine appropriate utilization in practice.     

Health Care Disparities and Demand for Expanding Hereditary Breast Cancer Screening Guidelines in African Americans

BackgroundGenomic medicine has led to significant advancements in the prevention and treatment of cancer. The National Comprehensive Cancer Network (NCCN) guidelines recommend BRCA1/2 screening in high-risk individuals; however, the guidelines have not incorporated differences within ethnic cohorts beyond Ashkenazi Jewish ethnicity. We analyzed the prevalence of BRCA1/2 mutations in various ethnicities and identified high-risk personal characteristics and family history incorporating differences within ethnic cohorts beyond Ashkenazi Jewish ethnicity.Patients and MethodsWe reviewed data collected by a Michigan medical genetic clinic in a community-based hospital from 2008 to 2018. A retrospective chart analysis was conducted of 1090 patients who received genetic counseling regarding hereditary cancer syndromes.ResultsWe found a statistically significant higher rate of pathogenic BRCA1/2 mutation prevalence in African American patients, at 8.1%, compared to non-Ashkenazi Jewish white patients, at 3.6% (P = .02). African Americans have a mutational prevalence nearing that of the Ashkenazi Jewish population.ConclusionRevision of the NCCN guidelines regarding hereditary cancer syndrome testing in various ethnic groups is imperative and overdue. Future studies are needed to identify health care disparities in and socioeconomic barriers to genetic testing.     

Clinicopathologic and Demographic Evaluation of Triple-Negative Breast Cancer Patients among a Turkish Patient Population: a Single Center Experience

Background: To evaluate the clinicopathologic and demographic characteristics of triple-negative breastcancer (TNBC) patients and to determine differences from non-triple-negative cases. Materials and Methods: Adetailed review of the medical records of 882 breast cancer (BC) patients was conducted to obtain informationregarding age, menopausal status, height and weight at the time of diagnosis, presence of diabetes or hypertension,and pathologic characteristics of the tumor (tumor size, lymph node status, histologic grade, ER status, PRstatus, HER2 status, p53 mutation). Body mass index (BMI) was calculated and a value of ≥30 was consideredas indicative of obesity. Results: 14.9% (n=132) of the patients had TNBC. There was no difference among thepatients in terms of median age, comorbid conditions and menopausal status. The proportion of medullary,tubular and mucinous carcinomas was significantly higher (15.9%) in the triple-negative (TN) group, whileinvasive lobular histology was more frequent (8.2%) among non-triple negative (NTN) cases (p<0.001). Grade 3(G3) tumors were more frequent in the triple-negative group (p<0.001). The rate of p53 mutation was 44.3% inTN tumors versus 28.2% in the NTN group (p<0.001). The two groups were similar in terms of LN metastasis. Inthe NTN group, the rate of patients with BMI ≥30 was 53% among postmenopausal patients, while it was 36%among premenopausal women, and the difference was statistically significant (p<0.001). No significant differencewas observed in terms of BMI between postmenopausal and premenopausal patients in the TN group (p=0.08).Conclusions: TNBC rates and clinicopathologic characteristics of the Turkish patient population were consistentwith the data from Europe and America. However, no relationship between obesity and TNBC was observed inour study. The association between TNBC and obesity needs to be evaluated in a larger patient population.     

Rates of Positive Surgical Margins and Their Effect on Cancer-specific Mortality at Radical Prostatectomy for Patients With Clinically Localized Prostate Cancer

Background

The objective of this study was to investigate positive surgical margin (PSM) rates in patients with prostate cancer treated with radical prostatectomy (RP) and assess PSM impact on cancer-specific mortality (CSM).

Racial Disparities in Lung Cancer Survival: The Contribution of Stage,Treatment, and Ancestry

Introduction

Lung cancer is a leading cause of cancer-related death worldwide. Racial disparities in lung cancer survival exist between blacks and whites, yet they are limited by categorical definitions of race. We sought to examine the impact of African ancestry on overall survival among blacks and whites with NSCLC cases.

Healthcare Disparities and Outcomes of Cancer Patients in a Community Setting from a COVID-19 Epicenter

There have been numerous studies demonstrating how cancer patients are at an increased risk of mortality. Within New York City, our community hospital emerged as an epicenter of the first wave of the pandemic in the spring of 2020 and serves a unique population that is predominately uninsured, of a lower income, and racially/ethnically diverse. In this single institution retrospective study, the authors seek to investigate COVID-19 diagnosis, severity and mortality in patients with an active cancer diagnosis. Demographic, clinical characteristics, treatment, SARS-CoV-2 laboratory results, and outcomes were evaluated. In our community hospital during the first wave of the COVID-19 pandemic in the United States, patients with active cancer diagnosis appear to be at increased risk for mortality (30%) and severe events (50%) due to the SARS-CoV-2 infection compared to the general population. A higher proportion of active cancer patients with Medicaid insurance, Hispanic ethnicity, other race, and male sex had complications and death from COVID-19 infection. The pandemic has highlighted the health inequities that exist in vulnerable patient populations and underserved communities such as ours.     

Metastatic Bone Disease as Seen in Our Clinical Practice - Experience at a Tertiary Care Cancer Center in Pakistan

Aim: Metastatic tumor of bone is the most common malignancy involving bone and is an important predictorof prognosis in advanced cancers. The prognosis depends upon the primary site of origin and the extent of disease.In current study, we present the pattern and distribution of metastatic bone disease seen in the leading cancer carecenter of Pakistan, Shaukat Khanum Cancer Hospital & Research Center (SKMCH & RC), Lahore. Materials& Methods: All cases of bony metastatic disease were included that presented in the Pathology Department ,from Jan 2005 to July 2011. Patients of all ages and both sexes were included. Primary bone tumors, lymphomas,sarcomas and other malignancies were excluded. The data were recorded and analyzed with SPSS 16.0. Results:A total of 146 cases of metastatic bone disease were included in the study. Out of the total cases, 79 were maleand 67 were female. Age range 25-82 years (median 52). Hip bone was the most frequent bone involved, withfemur and vertebrae as second and third in the list. The commonest bone involved in males was vertebrae with23 cases and in females was hip bone with 22 cases. Regarding primary site, cancers of breast, prostate andgastrointestinal tract were at the top of the list with prostate and breast being the most frequent primary sitesof metastasis in males and females respectively. Conclusion: Bone metastasis is an important entity to considerin the differential diagnosis whenever a bony tumor especially carcinoma present in older age. Our data arecomparable with international findings and the literature available regarding the site and distribution of skeletalmetastatic lesions. A slight deviation noted was more common bony metastatic lesions with ovarian primariesin females and gastrointestinal tract cancers in males in our study.     

Racial and Ethnic Disparities in Renal Cell Carcinoma: An Analysis of Clinical Characteristics

Background

Racial/ethnic minority groups, including Hispanic Americans (HAs) and Native Americans (NAs), have a heavier burden of kidney cancer than European Americans (EAs). We investigated variations in clinical characteristics of HA and NA patients with renal cell carcinoma (RCC) who were previously underrepresented.